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R H Wachsberg

Publications and source records attributed to R H Wachsberg.

At least 19 recordsLinked to original sources
PubMed2004

Pitfalls in the CT diagnosis of appendicitis.

CT evaluation of appendicitis represents an increasingly common emergency room request. While the overall accuracy of CT is high, numerous pitfalls exist which may deceive radiologists, resulting in a missed diagnosis of appendicitis. The inflamed appendix may be unusual in its location, or may appear normal if only a small portion of the distal appendix is involved (tip appendicitis). In a patient with a history of appendectomy, inflammation of the appendiceal stump may be easily missed. Appendicitis may closely mimic small bowel obstruction, or gynaecological disease, especially after perforation has occurred. Even a misleading clinical history may lead the radiologist's eye astray. This pictorial review demonstrates these and other potential radiological pitfalls, and includes important points for the accurate diagnosis of appendicitis.

Adolescent↗
PubMed2000

Respiratory variation of the diameter of the pancreatic duct on sonography.

OBJECTIVE: The objective of this study was to assess the prevalence of a 1-mm or greater increase in the diameter of the pancreatic duct during deep inspiration in patients without pancreatic disease. MATERIALS AND METHODS: A retrospective review was performed of normal findings on pancreatic sonograms of 25 consecutive lean patients without pancreatic disease who were capable of taking deep breaths. The anteroposterior diameter of the pancreatic duct in the body of the gland was measured at end-expiration and end-inspiration. A significant change was defined as a 1-mm or greater difference between the end-inspiratory and end-expiratory diameters for at least two of three consecutive breaths. RESULTS: Seven patients (28%) had a significant increase in the diameter of the pancreatic duct at end-inspiration. These included four patients (16%) in whom the diameter of the duct was less than or equal to 2.5 mm (i.e., normal) at end-inspiration and three patients (12%) in whom the diameter of the duct was greater than 2.5 mm at end-inspiration. CONCLUSION: The diameter of the pancreatic duct can increase during deep inspiration in some adults without pancreatic disease. This finding should be borne in mind as a potential pitfall during pancreatic sonography.

Adult↗
PubMed2000

Narrowing of the upper abdominal inferior vena cava in patients with elevated intraabdominal pressure: sonographic observations.

Focal narrowing of the upper intrahepatic inferior vena cava on computed tomography performed in patients with elevated intraabdominal pressure has been reported recently. The purpose of this study was to assess this phenomenon further with gray scale and duplex Doppler sonography. Seven patients with elevated intraabdominal pressure due to massive ascites in whom computed tomography showed narrowing of the intrahepatic inferior vena cava were studied. Sonography confirmed focal narrowing of the intrahepatic inferior vena cava that persisted throughout the respiratory and cardiac cycles. The narrowed inferior vena cava segment had a characteristic slitlike appearance on transverse images, slightly oblique to the sagittal plane. A focal flow jet typical of stenosis was observed in the three patients in whom Doppler sonography technically was feasible. In three of four patients who were able to sit or to turn into the left lateral decubitus position, the narrowing immediately resolved after the positional change but promptly recurred upon return to the supine position. In patients with elevated intraabdominal pressure, focal slitlike narrowing of the intrahepatic inferior vena cava is an anticipated finding that should not be misinterpreted as evidence of stenosis of the inferior vena cava or of a juxtacaval liver lesion.

Abdomen↗
PubMed2000

Non-Asian hepatocellular carcinoma: correlation between histologic features and echogenicity.

Studies of hepatocellular carcinoma in Asia have revealed a correlation between lesion hyperechogenicity and five histologic features: nonliquefied necrosis, sinusoidal dilatation, hemorrhage, fatty metamorphosis, and fibrosis. However, this correlation has not been investigated for non-Asian hepatocellular carcinoma, despite substantial differences between the Asian and non-Asian forms of this carcinoma. We retrospectively reviewed records of 29 patients seen at one United States institution who had hepatocellular carcinoma lesions that were either completely hyperechoic or completely hypoechoic. Tissue specimens obtained surgically (n = 7) or percutaneously (n = 22) were evaluated microscopically for the presence of nonliquefied necrosis, sinusoidal dilatation, hemorrhage, fatty metamorphosis, and fibrosis. A statistically significant correlation was identified between the number of histologic features identified and lesion diameter (P = 0.04) but not between the number of histologic features identified and the likelihood of hyperechogenicity (P = 0.11). Two lesions (50%) with three histologic features, four lesions (40%) with two histologic features, and six lesions (55%) with one histologic feature were hypoechoic. The echogenicity of non-Asian hepatocellular carcinoma lesions cannot be attributed to the histologic features that are believed to underlie echogenicity of the Asian type of hepatocellular carcinoma.

Adult↗
PubMed1999

Duplex Doppler sonography of small (<3 cm diameter) liver tumours: intralesional arterial flow does not exclude cavernous haemangioma.

In small liver lesions (<3 cm diameter), detection of internal arterial flow with duplex Doppler sonography is thought to virtually exclude the diagnosis of cavernous haemangioma. We retrospectively reviewed 114 consecutive small lesions confirmed or suspected to be haemangiomas. Doppler sonography revealed intralesional arterial flow in four lesions for which correlative imaging studies were diagnostic of haemangioma, and for which stability was documented with follow-up sonography. We conclude that intralesional arterial flow should not be interpreted as conclusive evidence that a small liver lesion is not a haemangioma. If the presence of arterial flow within a small liver lesion prompts concern that the lesion is not a haemangioma, our findings suggest that a correlative imaging study should be considered before percutaneous biopsy is performed.

Adult↗
PubMed1998

Sonographic endometrial three-layer pattern in symptomatic first-trimester pregnancy: not diagnostic of ectopic pregnancy.

PURPOSE: We evaluated a recent report that suggested that a "3-layer" appearance of the endometrium on sonography is diagnostic of ectopic pregnancy in symptomatic pregnant patients. METHODS: We reviewed the log of pelvic sonograms performed to rule out ectopic pregnancy in women presenting with first-trimester bleeding and/or pain during a 29-month period. Medical records and sonograms of patients without sonographic evidence of intrauterine pregnancy were reviewed to determine final diagnoses and whether the 3-layer pattern was present. RESULTS: One hundred twenty patients with available follow-up had no sonographic evidence of intrauterine pregnancy. Fifty-nine (49%) had ectopic pregnancy. An endometrial 3-layer pattern was noted sonographically in 15 patients (13%), of whom 6 (40%) had ectopic pregnancy. As a diagnostic sign of ectopic pregnancy, the endometrial 3-layer pattern had a sensitivity of 10.2%, specificity of 85.2%, positive predictive value of 40%, negative predictive value of 50.5%, and accuracy of 49.2%. CONCLUSIONS: The endometrial 3-layer pattern is neither sensitive nor specific for the diagnosis of ectopic pregnancy.

Adult↗
PubMed1998

Echogenic peritoneal fluid as an isolated sonographic finding: significance in patients at risk of ectopic pregnancy.

Echogenic intraperitoneal fluid in any quantity noted on sonography is thought to indicate a very high likelihood of ectopic pregnancy (EP) in patients at risk. We retrospectively reviewed 12 consecutive symptomatic patients with a positive pregnancy test in whom sonography revealed echogenic fluid as an isolated finding without evidence of intrauterine pregnancy and in whom follow-up was available. Final diagnoses were EP in seven patients (58%) and spontaneous abortion in five (42%). EP was diagnosed in all four patients with a large amount of echogenic fluid, but in only three (38%) of eight patients with a small-to-moderate amount of echogenic fluid. We conclude that a small-to-moderate amount of echogenic fluid noted as an isolated finding may not be highly predictive of EP.

Ascitic Fluid↗
PubMed1998

Unilateral absence of ureteral jets in the third trimester of pregnancy: pitfall in color Doppler US diagnosis of urinary obstruction.

Among 23 asymptomatic pregnant women with ureteral jets noted at color Doppler ultrasonography, jets were detected at only one ureteral orifice in three (13%) during the third trimester. In each such case, normal jets were detected from the suspicious ureter after the patient turned to the contralateral decubitus position. A unilaterally absent jet noted in the third trimester of pregnancy should not be interpreted as a sign of ureteral obstruction unless the finding persists in the contralateral decubitus position.

Female↗
PubMed1998

Sonographic versus endoscopic retrograde cholangiographic measurements of the bile duct revisited: importance of the transverse diameter.

OBJECTIVE: The purpose of this study was to investigate how frequently the cross section of the bile duct is oval versus round on sonography and whether the transverse diameter of the bile duct (DTRV) on sonography corresponds better than the conventional anteroposterior diameter (DAP) to measurements on endoscopic retrograde cholangiography (ERC). SUBJECTS AND METHODS: In 44 consecutive patients with a DAP greater than or equal to 8 mm, DTRV was measured on short-axis sonograms. Diameter of the bile duct measured on ERC (DERC) was compared with DAP and DTRV in patients who underwent ERC shortly after sonography. RESULTS: The cross section of the bile duct was oval in 31 patients (70%). In 20 patients who underwent ERC after sonography, mean DERC was statistically indistinguishable from mean DTRV but statistically different from mean DAP. Comparing both DAP and DTRV with DERC in each patient, we found no statistically significant difference between DERC and DTRV, but we did find a statistically significant difference between DERC and DAP. CONCLUSION: An oval cross section is common in bile ducts with a DAP greater than or equal to 8 mm. The discrepancy between measurements of the bile duct made sonographically and those made on ERC is largely attributable to different cross-sectional diameters. Because DTRV correlates better than conventional DAP with DERC, measurement of DTRV can be helpful in confirming or excluding true biliary dilatation in patients with a DAP larger than normal.

Adolescent↗
PubMed1997

Echogenicity of hepatic versus portal vein walls revisited with histologic correlation.

The portal vein wall typically is hyperechoic over a wide range of beam-vessel angles, whereas the hepatic vein wall is hyperechoic only when the incident beam and the vessel are perpendicular. This has been attributed to marked discrepancies in mural thickness, collagen content, or perivascular fat between portal and hepatic veins. We evaluated histologically the walls of portal and hepatic veins using three cadaveric livers. For vessels with luminal diameter above 2 to 3 mm, hepatic vein and portal vein wall thicknesses were similar such that portal vein walls were not more than 50% thicker than those of hepatic veins of comparable size. Hepatic vein walls were mostly composed of parallel, tightly packed collagen fibers. In contrast, portal vein walls were composed of loosely arrayed, nonparallel connective tissue fibers which were separated by multiple intervening spaces and only a minority of which were collagenous. Perivascular fat was not identified adjacent to intrahepatic vessels beyond the liver hilus. The marked differences in echogenicity between portal vein and hepatic vein walls typically observed at ultrasonography thus cannot be attributed to differences in mural thickness, collagen content, or perivascular fat between these vessels. Rather, the distinct composition of the hepatic vein wall renders it a specular reflector, which is hyperechoic only when the angle between the ultrasound beam and the vessel wall is close to 90 degrees, whereas the composition of the portal vein wall enables it to appear hyperechoic at a wide range of beam-vessel angles.

Aged↗
PubMed1996

Low attenuation of acute traumatic hemoperitoneum on CT scans.

OBJECTIVE: This study was undertaken to determine the incidence of low attenuation values in intraperitoneal hemorrhage, which could be confused with ascites. MATERIALS AND METHODS: We retrospectively analyzed the CT scans of 42 consecutive patients with hepatic and splenic lacerations and intraperitoneal fluid after blunt abdominal trauma. Patients were excluded if they had prior peritoneal lavage, bladder or bowel injury, or low hematocrit values. Intraperitoneal fluid was categorized by the site of accumulation (perihepatic, perisplenic, Morison's pouch, paracolic gutters, or pelvis). The amount of fluid in each intraperitoneal location was categorized as small, moderate, or large. Attenuation values were obtained from each intraperitoneal site, and overall mean attenuation values were determined for each patient. We correlated the size of each fluid collection with the attenuation value. We also compared attenuation values at locations adjacent to the site of each injury with those at other intraperitoneal sites. We then evaluated technical factors that could have lowered attenuation values, including CT miscalibration, volume averaging, and beam-hardening artifacts. RESULTS: For the 42 patients, we measured 131 separate attenuation values. Attenuation values ranged from 0 to 80 H, with attenuation of 24% of sites (32/131) measuring less than 20 H. Only 16% of sites (21/131) had attenuation values greater than 45 H. Attenuation at the remaining 78 sites (60%) measured from 20 to 45 H. All intraperitoneal locations except the pelvis had mean attenuation values significantly lower then 40 H. Mean attenuation values (determined by averaging measurements from different intraperitoneal sites) were also calculated for each patient. Only 6 (14%) of 42 patients had mean attenuation values greater than 40 H, whereas 4 (10%) of 42 patients had mean attenuation values less than 20 H. The remaining 32 patients (76%) had mean attenuation values between 21 and 40 H. Patients with hepatic lacerations showed no significant difference (p = .3509) in attenuation between perihepatic fluid and the remainder of intraperitoneal fluid. However, in patients with splenic lacerations, perisplenic fluid had a significantly higher (p = .0013) attenuation value (43 H) than did fluid at other intraperitoneal locations. CONCLUSION: Low attenuation measurements for acute hemoperitoneum represented a common finding that was not attributable to technical factors or underlying anemia. Fluid with attenuation values less than 20 H in acute trauma should not be dismissed as ascitic fluid.

Abdominal Injuries↗